A look at the growing specialty of hospitalist
The number of hospitalists has increased from the few hundred doctors practicing in 1996 to more than 50,000 working today in
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Traditionally, medicine in the hospital has been supervised and practiced by residents who report back to and work with primary care physicians. As the trend to increase quality of care while cutting costs has gained momentum, the role of the doctor practicing medicine in the hospital has expanded. Just as the practices of emergency and critical care medicine have evolved to require specialized skills, so has the practice of hospital medicine.
Dr.
"Hospital medicine began to appear because the traditional model of medicine was becoming distressed," Nelson said.
Nelson said large numbers of hospitalists exist because primary care doctors who historically cared for patients in the hospital and outpatient settings have found it difficult to "stay on top of their game" in both settings and to be reliably available in both settings simultaneously. Before the arrival of hospitalists, he said, doctors would see patients during the day and hospitalized patients during rounds in the early mornings or in the evenings.
"The frantic, intense schedules for these doctors was not only stressful, but patients didn't have reliable access to the doctor for scheduled appointments or hospital emergencies," he said.
Only when executives began to see the cost-saving benefits emerge from the increasing numbers of internists working exclusively in the hospital, did they too begin to support the trend. Nelson said the concept of the hospitalist as a new model germinated with physicians in the trenches who chose to narrow their practice to only outpatient settings. As these doctors began to move out of the hospital, they left a void that was filled by hospitalists.
The idea that doctors have been pushed to leave the hospital is also somewhat of a distortion, said Nelson. This happened in rare cases that got a lot of attention. Medicine has become too complex for individual doctors to be juggling multiple medical roles across different settings (outpatient and hospital) all at once. It is doctors themselves who have brought about the rapid adoption of the hospitalist model across the country. And hospital and insurance executives have been ardent supporters of its growth.
Patients who don't yet understand the benefits of having physicians who practice exclusively and intensively in a hospital setting and who would like to be cared for by their private physicians, tend to unfairly blame hospital administrators, government medical overseers and insurance executives for the inability to be treated by doctors with whom they may have bonded, Nelson said.
Hospitals, meanwhile, have become complex settings with individualized protocols. They are now the sites of new, innovative technology and complicated systems that require a full-time focus. Most patients are now treated in an office or outpatient facility and only in hospitals when they are very ill. As the average hospital stay becomes shorter, the efficiency and continuity of care that only full-time physicians and staff working as a team can provide has become vital. As hospitals develop new services and protocols, hospitalists, who understand how the hospital works better than other doctors, have become participants in hospital-driven changes.
An area of hospital medicine that can still be problematic and requires work and improvement is the potential lack of communication between a hospitalist and an individual's primary physician.
Dr.
"It's more efficient, productive and healing to have an experienced navigator (the hospitalist) working with a known team," said Handa, "and when it works as it should to encourage continuity of health treatment and planning, the best intended results of the model have been realized."
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